AccountId: 011433970860
ContactId: c2005882-ce30-454e-93dc-c775d7c3093f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 184210 ms
Total Talk Time (AGENT): 66570 ms
Total Talk Time (CUSTOMER): 93211 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/c2005882-ce30-454e-93dc-c775d7c3093f_20250602T14:30_UTC.wav
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[AGENT][NEUTRAL] For calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Yes, hi, good morning, [PII]. My name is [PII] and I'm calling the provider of office and I'm trying to get information regarding a secondary claim.
[AGENT][POSITIVE] I'd be happy to assist with the claim today [PII] if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Uh, the callback number is [PII]. My extension is [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] On the policy number that I have on file is 1,477,500.
[CUSTOMER][NEUTRAL] ML 7.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, the patient name is [PII], [PII].
[AGENT][NEUTRAL] And the date of service for the claim?
[CUSTOMER][NEUTRAL] Uh, the data servicing on the claim is way back on [PII]. The total charge is $4,255.
[AGENT][NEUTRAL] And your tax ID?
[CUSTOMER][NEUTRAL] Uh, the tax ID is [PII].
[AGENT][POSITIVE] Thank you for that one moment.
[AGENT][NEGATIVE] It looks like we received that claim 3 times. The first time it denied because the um.
[AGENT][NEGATIVE] Maximum outpatient for that day had already been exhausted and the last two times it denied as duplicates.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So, when you mean by mm the first one, it says the maximum benefit is already exhausted, but it doesn't state it here it's gonna be responsible for that, on that remittance advice that we have. That's why I'm calling regarding that.
[AGENT][NEUTRAL] Well, we don't determine patient responsibility, so, but it's the patient responsibility I guess if we're not paying.
[CUSTOMER][NEUTRAL] Oh, you, you, you, you're just not paying. OK. Oh, I'm just gonna send this to the patient and let him call you guys regarding this. All right. Thank you, Ma. Do you have any call reference number or just user name?
[AGENT][NEUTRAL] So just so that we clear the claim denied the claim denied because they have a $1000 per day and the facility filed first, so the facility got the full $1000. So that's why your claim denied. We got it second and we had already paid the facility.
[CUSTOMER][POSITIVE] Hi [PII], I'm sorry.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The remainder it's patient responsibility, but you know they can call and we can explain that to them. Um, the reference for the call is just gonna be my name [PII] last initial [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] That, that's it, [PII], thank you.
[AGENT][POSITIVE] Thank you for calling APL you have a good day.
[CUSTOMER][NEUTRAL] You too bye.